ORTHOPAEDIC ONCOLOGYCLINICAL CASE STUDY

Clinical HistoryA 24-year-old female is referred to the Orthopedic Oncology Service at Roth-man Institute for evaluation for a pelvis bone lesion seen on imaging. About eight months ago she first developed right-sided low back pain and pain radiating down her right leg. An MRI of the lumbar spine was done. A large bone lesion was seen, involving a significant portion of her right hemipel-vis, and a portion of the sacrum and spine. A CT scan of the pelvis was ordered to better evaluate this lesion, which confirmed an aggressive appearing tumor of the pelvis, sacrum and spine. Once this imaging was completed, the patient was referred to Dr. Abraham, chief of the Orthopedic Oncology service at Rothman Institute for further workup and management of this malignant pelvis tumor.

ROTHMAN INSTITUTE

Orthopaedic SurgeryJohn A. Abraham, MDKristin Strogus, PA-C

Medical OncologyAtrayee Basu-Mallick, MD

Radiation OncologyWenyin Shi, MD, PhDMark Hurwitz, MD

General SurgeryAdam Berger, MD

Thoracic SurgeryNate Evans, MD

Plastic SurgeryPatrick Greaney, MD

Musculoskeletal RadiologyWilliam Morrison MDDiane Deeley MDSuzanne Long MDAdam Zoga MD

Bone and Soft Tissue PathologyBrian O’Hara MDAnthony Prestipino MDWei Jiang MD PhD

Rehabilitation MedicineDeborah Franklin MD

Anesthesia and Pain ManagementKishor Gandhi MD

The OsteosarcomaTreatment Team

Workup and Treatment

Based on the appearance of the tumor on the imaging, the sus-pected diagnosis is pelvic osteo-sarcoma. A biopsy is performed, which confirms the diagnosis. Staging studies are performed, which confirms that the tumor is localized to the pelvis only, with no sign of metastatic disease. Osteo-sarcomas of the pelvis are rare, with only about 100 such tumors seen in the entire US per year. Treatment of Pelvic Osteosarco-ma requires the expertise of a multidisciplinary team familiar with osteosarcoma treatment, such as the Musculoskeletal Oncology Center at Jefferson. The patient is referred to Dr. Basu-Mallick, a Sarcoma Medical Oncologist, for initiation of the neoadjuvant che-motherapy protocol.

Surgical Treatment

Final PathologyThe tumor was evaluated by the Bone and Soft Tissue Pathology service. The resection demonstrat-ed a negative margin in all planes of the resection. This is the best surgical result that can be achieved when dealing with these aggressive tumors, and significant-ly improves the patient’s chance for survival.

The surgical treatment of Pelvic Osteosarcoma is extremely chal-lenging. Only a few centers in the country have the expertise neces-sary to safely and adequately remove these tumors. Dr. John Abraham, chief of the division of Orthopedic Oncology at the Roth-man Institute, and Director of Jefferson’s Musculoskeletal Oncology Center, has pioneered the use of technology known as surgical navigation to assist in the resection of complex tumors such as this one. Using this system, a highly precise 3 dimensional image of the tumor and surround-ing tissues can be seen intra-op-eratively in real time. This makes the resections not only safer, but also increases the surgeon’s abili-ty to achieve a negative margin resection, which is critical to the patient’s disease free survival. Preoperative planning was done at the weekly Sarcoma and Mus-culoskeletal Oncology treatment planning conference, with the input from the Musculoskeletal Radiology and Bone and Soft

To Refer APatient

Call our Physician Referral hotline, RI Connect: 800-411-6626

Visit us at:

www.rothmaninstitute.com, clickon “make an appointment.”

For more information visit www.rothmaninstitute.com, click onOrthopaedic Oncology under the Specialties section.

The Orthopedic Oncology service at Rothman Institute is the only center in the region with expertise in the utilization of surgical naviga-tion for resection of bone tumors. As demonstrated by this case, achieving a negative margin is extremely challenging, yet is abso-lutely critical to the best patient outcome. Dr. Abraham believes this technology has increased his ability to safely and completely remove even the most challenging of skeletal tumors like this one, and is thrilled about the benefits that it can offer his patients with difficult bone tumors.

Did You Know?Tissue Pathology teams. In this case, an extremely complex 12 hour operation was performed by Dr. Abraham. A navigation assisted resection including the right hemi-pelvis, right hemi sacrum, and the right half of the L5 vertebral body was performed.

John A. AbrahamChief, Orthopaedic Oncology